Maternal-Fetal Medicine Practice Questions

Q: Treatment of choice in placenta accreta :

Hysterectomy. ***Hysterectomy*** - In cases of **placenta accreta**, the placenta abnormally invades the uterine wall, making separation difficult and risking severe hemorrhage. - **Hysterectomy** is the treatment choice to prevent life-threatening bleeding and remove the abnormally adherent placenta along with the uterus. *Manual removal* - **Manual removal** is contraindicated in placenta accreta as it can lead to massive hemorrhage due to the abnormal placental adherence. - This method is typically used for uncomplicated, retained placentas that are not abnormally invasive. *Hysterotomy* - **Hysterotomy** is an incision into the uterus and is not a definitive treatment for placenta accreta. - While it may be used to deliver the baby in certain obstetric scenarios, it does not address the underlying issue of placental adherence. *Wait and watch* - A **wait and watch** approach (expectant management) is associated with a high risk of life-threatening hemorrhage and infection in placenta accreta. - This strategy is not recommended for cases of confirmed placenta accreta due to the significant maternal morbidity and mortality.

Q: Medical treatment of ectopic pregnancy is :

Methotrexate. ***Methotrexate*** - **Methotrexate** is the primary medical treatment for **unruptured ectopic pregnancies** in stable patients. - It works by inhibiting **folate reductase**, stopping rapidly dividing cells, which leads to the dissolution of the ectopic gestational tissue. *Oestrogen* - **Oestrogen** (estrogen) is a female sex hormone primarily involved in the development and regulation of the female reproductive system and secondary sex characteristics. - It is not used to treat ectopic pregnancies and may even promote growth of uterine tissue, which is not desired in this context. *Adriamycin* - **Adriamycin** (doxorubicin) is an **anthracycline chemotherapy agent** used primarily in the treatment of various cancers. - It has significant side effects and is not indicated for the treatment of ectopic pregnancy. *Progesterone* - **Progesterone** is a hormone essential for maintaining pregnancy and is often used to support early pregnancies, especially in cases of threatened miscarriage. - It would work against the goal of terminating an ectopic pregnancy and is therefore contraindicated.

Q: Soft markers on ultrasonography are helpful in diagnosing?

Chromosomal anomalies. ***Chromosomal anomalies*** - **Soft markers** are sonographic findings that, while not structural anomalies themselves, are **statistically associated** with an increased risk of chromosomal abnormalities, particularly **Down syndrome (Trisomy 21)** and other aneuploidies. - Common examples include **nuchal fold thickening**, **echogenic intracardiac focus**, **choroid plexus cysts**, **pyelectasis**, **shortened long bones**, and **echogenic bowel**. - These markers help identify pregnancies at higher risk for chromosomal anomalies and guide decisions about further diagnostic testing (e.g., amniocentesis, NIPT). *Site of pregnancy* - The site of pregnancy (intrauterine vs. ectopic) is determined by direct visualization of the **gestational sac** and **embryo** within or outside the uterine cavity. - Soft markers do not indicate pregnancy location. *Fetal size* - **Fetal size** is assessed through biometric measurements: **crown-rump length (CRL)** in the first trimester, and **biparietal diameter (BPD)**, **head circumference (HC)**, **abdominal circumference (AC)**, and **femur length (FL)** in later pregnancy. - These are growth parameters, distinct from soft markers for chromosomal risk. *Fetal age* - **Fetal age** (gestational age) is primarily determined by **crown-rump length (CRL)** in the first trimester, which is the most accurate method. - Later, BPD, HC, AC, and FL are used for dating, but soft markers do not determine fetal age.

Q: A lady with 10-12 wks pregnancy develops acute retention of urine. The likely cause is-

Retroverted uterus. ***Retroverted uterus*** - A **retroverted uterus** can become impacted in the **pelvic cavity** as it grows during pregnancy, causing compression of the urethra. - This impaction typically occurs between **10-14 weeks of gestation**, leading to acute urinary retention. *Prolapse uterus* - Uterine prolapse is less likely to cause acute urinary retention in early pregnancy, as the pregnant uterus tends to **ascend out of the pelvis** at this stage. - While prolapse can be associated with urinary symptoms, acute retention due to prolapse is more common in **non-pregnant** or **postpartum** states. *Fibroid* - A **fibroid**, especially a large one or one located in the lower uterine segment, can obstruct the bladder outlet. - However, the most classic cause of acute urinary retention in early pregnancy is a **retroverted uterus**, which is more commonly implicated than fibroids in this specific scenario. *Urinary tract infection* - A **urinary tract infection (UTI)** can cause dysuria, frequency, and urgency, and in severe cases, might lead to urinary retention due to urethral inflammation or bladder dysfunction. - While a UTI is possible, in the context of early pregnancy and acute retention, a **mechanical obstruction** from uterine displacement is a more specific and common cause.

Q: Which of the following is an indication for medical management in ectopic pregnancy?

Size <4 cm. ***Correct: Size 4 cm) have higher failure rates with medical management. *Incorrect: Presence of fetal heart activity* - The presence of **fetal heart activity** is a **contraindication** for medical management with methotrexate. - **Absence of fetal cardiac activity** is required for medical management eligibility. - When cardiac activity is present, surgical intervention is preferred due to **lower success rates** of methotrexate and increased risk of **persistent ectopic pregnancy** or **rupture**. *Incorrect: Gestation 1500* - For medical management eligibility, **β-hCG should be 1500 mIU/mL doesn't define suitability; rather, levels **>5000 mIU/mL** are associated with decreased efficacy and increased failure rates.

Q: Umbilical artery Doppler is done to assess

Placental function. ***Placental function*** - Umbilical artery Doppler assesses **blood flow resistance** within the placenta, which is a direct indicator of its functional capacity. - Increased resistance, indicated by a high **systolic/diastolic (S/D) ratio** or absent/reversed end-diastolic flow, suggests inadequate placental perfusion and function. *Fetal weight* - Fetal weight is primarily assessed through **ultrasound biometry**, measuring parameters like head circumference, abdominal circumference, and femur length. - While compromised placental function can affect fetal growth, Doppler itself does not directly measure fetal weight. *Fetal oxygenation* - Fetal oxygenation is more directly assessed through **non-stress tests (NST)**, **biophysical profiles (BPP)**, and fetal scalp blood sampling for pH. - Abnormal umbilical artery Doppler findings can *indirectly* suggest potential for reduced oxygenation due to placental insufficiency, but it's not a direct measure. *Fetal maturity* - Fetal maturity, particularly lung maturity, is assessed by analyzing **amniotic fluid** for ratios like **lecithin/sphingomyelin** or presence of **phosphatidylglycerol**. - Umbilical artery Doppler provides no information about fetal organ development or gestational age-related maturity.

Q: Placenta increta means:

Villi invade myometrium. ***Villi invade myometrium*** - **Placenta increta** is a condition where the **chorionic villi** invade into the **myometrium** (the muscular layer of the uterus) but do not penetrate through it. - This deep invasion prevents the normal separation of the placenta after birth, leading to significant complications like **hemorrhage**. *Villi are attached to lower uterine segment* - This describes **placenta previa**, where the placenta implants in the lower uterine segment, covering or nearly covering the cervical os. - While it can cause bleeding, it does not involve abnormal placental adherence to the uterine wall. *Villi are attached to myometrium* - This description is too general and most closely aligns with **placenta accreta**, where the villi attach to the myometrium without invading or penetrating it. - **Placenta accreta** is the least severe form of abnormally invasive placenta. *Villi penetrate through myometrium* - This describes **placenta percreta**, the most severe form of abnormally invasive placenta. - In **placenta percreta**, the chorionic villi penetrate **through the entire myometrium** and may invade adjacent organs like the bladder or rectum.

Q: Which of the following STDs causes fetal abnormality?

Syphilis. ***Syphilis*** - **Congenital syphilis**, resulting from maternal infection, can lead to severe fetal abnormalities such as **bone deformities**, **saddle nose**, **Hutchinson's teeth**, and **neurological problems**. - It can also cause stillbirth, prematurity, or hydrops fetalis, emphasizing the importance of early detection and treatment during pregnancy. *Herpes* - While **neonatal herpes** can be life-threatening and cause neurological damage, it is typically acquired during passage through the birth canal and does not cause **fetal abnormalities** during gestation. - Herpes simplex virus primarily causes localized lesions and systemic infection in the neonate, not developmental defects. *Gonorrhea* - Gonorrhea primarily causes **ophthalmia neonatorum** (conjunctivitis) in newborns through exposure during birth, which can lead to blindness if untreated. - It does not typically cause **fetal abnormalities** or congenital defects through transplacental transmission. *Hepatitis B* - Hepatitis B can be transmitted to the fetus during birth, leading to **chronic hepatitis B infection** in the infant. - Although it causes a chronic disease, it does not typically result in **fetal abnormalities** or congenital malformations.

Q: Most safe and effective evacuation in a patient with missed abortion at 14-16 weeks can be achieved with

Misoprostol. ***Misoprostol*** - **Misoprostol** is a **prostaglandin E1 analog** that ripens the cervix and stimulates uterine contractions, making it highly effective for inducing labor and expelling uterine contents in cases of missed abortion, especially in the second trimester (14-16 weeks). - Its oral or vaginal administration offers a **non-invasive**, safe, and cost-effective approach for uterine evacuation, minimizing the risks associated with surgical procedures. *Extra-amniotic ethacrydyl lactate* - Extra-amniotic ethacrydyl lactate is an older method that is **not commonly used** for cervical ripening and uterine evacuation due to better, safer, and more effective alternatives. - This method involves injecting a substance outside the amniotic sac, which can carry a **higher risk of infection** and potentially incomplete evacuation compared to modern approaches. *Carboprost* - **Carboprost** is a **prostaglandin F2 alpha analog** primarily used to manage **postpartum hemorrhage** and is less commonly the first-line agent for evacuating missed abortions at this gestation. - While it can induce contractions, its side-effect profile (e.g., **bronchospasm**, **gastrointestinal upset**) and specific indications make it less ideal for routine induction for missed abortion compared to misoprostol. *Oxytocin* - **Oxytocin** is effective in stimulating uterine contractions mainly when the cervix is already ripe or near term, but it is **less effective** for cervical ripening and prolonged induction in the second trimester for missed abortion. - In cases of missed abortion at 14-16 weeks, the uterus is less responsive to oxytocin alone, and large doses may be needed, which could carry increased risks.

Q: Fetus starts hearing by what time in intrauterine life:

20 weeks. ***20 weeks*** - The **cochlea** and auditory structures of the inner ear reach **structural maturity** around **20 weeks of gestation**, marking the anatomical basis for hearing capability. - At this gestational age, the **cochlear hair cells** and **spiral ganglion** are sufficiently developed to transmit auditory signals. - This is the **conventional answer** in medical education, representing when the anatomical structures necessary for hearing are first functional. - While more consistent behavioral responses occur later (24-26 weeks), the initial capacity for sound perception begins around 20 weeks. *14 weeks* - At 14 weeks, the **basic structures** of the ear are forming but remain immature. - The cochlea is still undergoing development, and the auditory pathway is not yet functional. - Sound perception capability is not present at this early stage. *32 weeks* - By 32 weeks, the auditory system is **highly mature** and well-developed. - The fetus demonstrates robust responses to various sounds and can distinguish between different voices. - However, this represents advanced auditory function, not the **onset** of hearing, which occurs much earlier at 20 weeks. *33 weeks* - At 33 weeks, the fetal brain shows **significant activity** in response to auditory stimuli with well-established neural pathways. - This is a stage of **refined hearing**, not the initial development of hearing capability. - The ability to hear has already been established weeks earlier.

Question 1

Treatment of choice in placenta accreta :

Accepted Answer

Hysterectomy

Answer

Manual removal

Answer

Hysterotomy

Answer

Wait and watch

Question 2

Medical treatment of ectopic pregnancy is :

Accepted Answer

Methotrexate

Answer

Oestrogen

Answer

Adriamycin

Answer

Progesterone

Question 3

Soft markers on ultrasonography are helpful in diagnosing?

Accepted Answer

Chromosomal anomalies

Answer

Site of pregnancy

Answer

Fetal size

Answer

Fetal age

Question 4

A lady with 10-12 wks pregnancy develops acute retention of urine. The likely cause is-

Accepted Answer

Retroverted uterus

Answer

Prolapse uterus

Answer

Fibroid

Answer

Urinary tract infection

Question 5

Which of the following is an indication for medical management in ectopic pregnancy?

Accepted Answer

Size <4 cm

Answer

Presence of fetal heart activity

Answer

Gestation <6 weeks

Answer

β-hCG>1500

Question 6

Umbilical artery Doppler is done to assess

Accepted Answer

Placental function

Answer

Fetal weight

Answer

Fetal oxygenation

Answer

Fetal maturity

Question 7

Placenta increta means:

Accepted Answer

Villi invade myometrium

Answer

Villi are attached to lower uterine segment

Answer

Villi are attached to myometrium

Answer

Villi penetrate through myometrium

Question 8

Which of the following STDs causes fetal abnormality?

Accepted Answer

Syphilis

Answer

Herpes

Answer

Gonorrhea

Answer

Hepatitis B

Question 9

Most safe and effective evacuation in a patient with missed abortion at 14-16 weeks can be achieved with

Accepted Answer

Misoprostol

Answer

Extra-amniotic ethacrydyl lactate

Answer

Carboprost

Answer

Oxytocin

Question 10

Fetus starts hearing by what time in intrauterine life:

Accepted Answer

20 weeks

Answer

14 weeks

Answer

32 weeks

Answer

33 weeks

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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